Notification of Changes for Business Entity
General Information
Business Entity Name:	NATIONAL HEALTH UNDERWRITERS, LLC
Incorporation / Formation Date:	04/09/2012
FEIN:	45-3641742
Ohio License Number:	946544
NPN:	16452470
DBA / Trade Name:	CHELSEA INSURANCE GROUP
State of Domicile:	OH
County:	GEAUGA
Business Address
Address 1:	8251 PINE CREEK CT
Address 2:
City:	CHAGRIN FALLS
State:	OH
Zip:	44023
Phone:	440-723-3229
Fax:
Business Web Site Address:
Business Email Address:
Mailing Address
Address 1:	8251 PINE CREEK CT
Address 2:
City:	CHAGRIN FALLS
State:	OH
Zip:	44023
Indicate the type of change you are seeking
Address Change:	YES
Business Entity Name Change:	NO	Old Business Entity Name:
New DBA/Trade Name:	YES	New DBA/Trade Name:	CHELSEA INSURANCE GROUP
Amend DBA/Trade Name:	NO	Old DBA/Trade Name:
Add/Delete Producers, Members, Owners, Partners, Officers and/or Directors:	NO

Licensed Producers
Name	Title	NPN	Add	Delete	Eff. Date

Members, Owners, Partners, Officers and Directors
Name	Title	Identifying #	Add	Delete	Eff. Date
ALAN SOLOMON

Title Business Entities Only
1. Is any member, producer, owner, share holder, manager, partner, officer or director currently engaged in deriving income from or affiliated with (other than as a customer) any business or profession other than insurance? (i.e. banking, auto dealer, mortgage company)	NO
2. Has any member, producer, owner, share holder, manager, partner, officer or director currently engaged in deriving income from or affiliated with (other than as a customer) any business or profession other than insurance since the filing of the previous CN-65 or the original application?	NO
3. If the answer to questions #1 or #2 is yes, identify the business or profession and the nature of person's involvement

Submitted By
Submitted By:	ALAN SOLOMON
Title:	MANAGING MEMBER
Phone Number:	440-723-3229
Email Address:	ALAN@CHELSEAINSURANCEGROUP.COM